Are we all Zoomed out? Do doctors miss patients’ wit and wisdom? Is a trip to the hospital the new fun field trip? Absolutely not! It was simply inevitable that after the incredible rise of virtual visits in 2020, that some virtual visits would revert back to in-person visits once a large percentage of the population got vaccinated. So the bell is not tolling for the future of telehealth even though according to the Monthly Telehealth Regional Tracker from FAIR Health, telehealth claims fell from 5.9 percent of claim lines in February 2021 to 5.6 percent in March 2021 and even considering the steeper drop of 15.7 percent the month before.
We’re largely not going back to that world of packed waiting rooms with people sleeping under chairs, just like we’re not going back to using wads of cash (anyone used a metal coin recently?) or Cathode-ray tube TVs or funky discos. There may be some consultations that will require a physical presence for testing and diagnosis. In those cases, the doctor needs to touch that bump or poke the otoscope in your ear. Those visits are and will be in-person. But it will remain cheaper, safer, more convenient, and more efficient (throughput and cost) to virtualize other visits. And sometimes a visit inside the hospital will even be virtualized. For example, if a specialized physician is located at a different medical center across the country or in a different part of the world, a doctor can use telehealth to efficiently deliver virtual care inside the building and to satellite facilities.
Virtual visits will settle down then start to rise again, just like the number of Zoom calls will settle then continue even after employees return to their offices. The future of all care and all personal relationships will become a hybrid model of blended in-person and virtual meetings. Meanwhile, hospital systems will take some time to carefully look at their virtual solutions, see what worked, what didn’t work, what software was good (disclosure: my company is a telehealth vendor), what was bad, and what improvements need to be made.
While some doctors may prefer in-person visits, hospital systems will likely prefer remote visits when practical because they are more efficient. Those hospital systems that do slide back to in-person visits will not achieve the patient throughput that virtual providers can — and it puts them at an efficiency disadvantage.
But — let’s not forget policy and money. Reimbursement policies can tilt the playing field. If telehealth visits are no longer equally reimbursed, this will tip the tables. Good common sense and good medical sense must be financially incentivized and rewarded. No one wants a patient to drive an hour to a hospital and wait there for a consult simply because an in-person consult was reimbursable, and a virtual consult was not.
The electronic medical records (EMR) system is always a consideration too. EMR data entry can sometimes be easier during an in-person visit but that’s a good reason to make EMRs better — not drag patients by the hair to a visit. The Department of Health and Social Services need to fight the good fight, too.
The 21st Century Cures Act – a bipartisan part of former President Donald Trump’s MyHealthEData initiative – compels providers to share data via standard APIs and forbids data blocking while standardizing data formats. That will make it easier for virtual visit records to get into a patient’s records. Now, while the EMR vendors nominally smirk towards interoperability, in practice those vendors don’t actually want interoperability and common standards. So, this process will drag on for months, maybe years. In his book “Promise Me, Dad” about the death of his son Beau in 2018, now-President Joe Biden spoke clearly and explicitly about the problems of EMR systems interoperability. So now it’s Biden’s turn to put his shoulder to the boulder, to believe that video connectivity and data interoperability are the future, to push for it, and to stop EMR vendors from laying out spike strips to puncture the tires of progress.
While the virtual visit numbers settle, we will see other telehealth trends will play out. These include:
- Data will show what types of visits are best delivered virtually using patient satisfaction scores and outcomes data. Psychotherapy and behavioral health sessions will likely score well.
- Systems will think through telemedicine delivery options and may in-source virtual visits (whether virtual or in-person.) Why pay AmWell to serve your own patients? Use technology to connect your own physicians to do the job, save money and retain the customer/consumer relationship.
- Virtual visit technology will improve. The video will get clearer, and the experience will improve. Home-based instruments will be able to be remotely controlled. Patient data will get into the patients’ records correctly and eventually the records will be shareable.
- Definitions of and reasons for reimbursability will change too. If a (human) doctor spends five minutes asking questions and recording answers, that time should be reimbursable. If an avatar doctor spends that same five minutes, it most likely isn’t reimbursable. Why? Why judge a physician by the minute spent and incentivize them to slow down to make a visit longer?
Ultimately, the consumers will win. They will prefer (when possible) to be treated in the comfort and familiarity of their own homes. Sure, telehealth visits may have dropped over the last two months but with five years’ hindsight, this will just be a little wobble on the inexorable march towards a virtualized healthcare future that is more efficient and effective.